Health Information Exchange And Patient Engagement

A mixed payment system combined with physician monitoring, will provide physicians with incentives to consider costs and benefits of different treatment options, which will lead to an efficient level and quality of care. (1,2)

The adoption of EHR has been slower than expected (Gans 1323). With numerous systems available, it is particularly difficult for a smaller practice to identify which system best meets its needs. Other notable challenges for some practices include assumption of the capital investment as well as managerial responsibilities associated with the IT infrastructure. A common implementation challenge encountered is the lack of a universal vision and definition of EHR. Since there are multiple interpretations of the definition of EHR and attendant requirements, identifying current and future needs is a complex process for potential users. Short term limited ability systems will eventually become obsolete as there is a move toward more global EHR systems. On June 18,

Healthcare providers that elect to participate in and receive reimbursement from Medicare must be licensed through their state, as well as, obtain and maintain certification for compliance with the Center for Medicare and Medicaid Services (CMS) Conditions of Participation (COPs). CMS is an agency within the Department of Health and Human Services that drafted guidelines for healthcare providers to meet acceptable minimum standards to operate and be reimbursed for services. Once providers are able to meet the COPs, they become a Medicare-Certified Agency and are granted a provider number. Each state is responsible for the certification of healthcare providers and a state survey is conducted every three years and as needed to determine if the healthcare provider continues to meet the minimum standards set in the COPs.

Electronic health records can provide many benefits for providers and their patients, but the benefits depend on how they 're used. Meaningful use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria. The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States. The Health Information Technology for Economic and Clinical Health (HITECH) Act provides the Department of Health & Human Services (HHS) with the authority to establish

The purpose of this discussion board is to describe the Electronic Health Record (EHR), the six steps of an EHR and how my facility implements them, describe “meaningful use” and how my facility status is in obtaining it, and to further discuss the EHR’s and patient confidentiality.

To better understand where my facilities progress is concerning EHR’s, I will first explain the six step process in implementing an EHR. In the first step, an organization must assess their preparedness to initiate an EHR. This includes their

Patients are surveyed about their recent experience and are asked about the quality of care, communication and timeliness. For example, there are condition categories that the CMS focuses on, such as Emergency department care. The CMS survey will measure the average time that emergency patients had to wait before being seen or receiving pain medication. The CMS report also provides statistics related to how likely patients will experience complications, readmissions and death. For example, hip or knee patients often experience complications after surgery. In addition to this, the CMS survey also monitors the use of medical imaging, such as MRIs and CTs, and how the patient payments match patient

Payment-determination bases are composed of three factors: cost, fee schedule, and price related. In a cost-payment basis the provider’s cost is the main method for payment (Cleverley, 2010). It is essentially a way to formulate fees for medical services. Prior to this practice, medical cost for medical services differ from state to state, which led to a variety of fee schedules. According to Brumley (2015), the varying fee schedules were inefficient for Medicare; therefore, to solve this issue Medicare linked fees to the actual cost of providing specific services. This became a component of the Section O of Title 42 in the code of Federal regulations; which sought to describe the different costs that can be included when it comes to calculating medical fees. The goal was to structure medical fees on a more cost-reasonable basis.

CCBHCs are entitled to receive enhanced payment via a Prospective Payment System (PPS), which is a method designed to reimburse providers based on the anticipated costs associated with serving the people in their community. This is beneficial because CCBHCs will be able to receive payment for numerous activities that are not usually funded through the current funding streams. For example, CCBHCs can receive payment for services rendered outside of the clinic itself, for peer services, telehealth, care coordination activities, and

In addition to the core elements, providers will have to choose any five of the ten additional tasks to implement in 2011-2012. Some examples of these might be clinical lab results, patient appointment reminders and drug-formulary checks. This gives the providers a chance to choose their own path toward full EHR implementation and meaningful use. Legislation ties payments to the achievement of advances in health care processes and outcomes. The regulations are specific as to when providers will have to use particular functions in order to be considered meaningful users. The meaningful use rule acknowledges the urgency of adopting the electronic health record and recognizes the challenges it will pose on all providers.

Centers for Medicare and Medicaid Services (CMS) adopted the Medical Severity Diagnosis Related Groups (MS-DRGs) for use in the Inpatient Prospective Payment System (IPPS) in the fiscal year 2008, which ran from October 1, 2007 through September 30, 2008. CMS was influenced by the Medicare Payment Advisory Commission (MEDPAC) and the hospital community to use a severity adjusted DRG system.

If the Centers for Medicare & Medicaid Services (CMS) change their payer regulations and accreditation requirements, hospitals would need to accommodate their requests for continued supplemental payments. In other words,

Ms. Kays provided the committee with information an update on the Medicare RAC review process. CMS had offered a settlement to try to address the large backlog of cases which paid hospitals to resolve pending appeals or waive the right to appeal in exchange for timely partial payment of 68% of the net payable amount. Ms. Keys explained that the Organization did not opt for the settlement. Review of the cases in question and related documentation supported revising the charges to reflect observation, not inpatient.

A readiness assessment can assist in identifying the readiness of an organization to successfully starting an EHR, the readiness for the staff to accept, and productively by using the EHR. The results will help assess what the current state of technology is, what is needed to make a

“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an